INSERSI - INSTRUKSI

- EVALUASI GTL
Bagus Aji Rahmawan (J2A013008)
Fara Setyo Dewi (J2A013017)
Gita Jazaul Aufa (J2A013026)
Glory Gustiara Firdaus (J2A013035)
Ficky Vimbiyanti Ardelia (J2A013044)
INSERTION
Insertion
Denture insertion is not a separate and distinct
from all other phases of denture fabrication it
may be regarded as a pause in treatment to
provide an overview that takes account of all phases
of treatment, which began with the initial interview.
 Before the insertion appointment inspect the dentures to determine

1) That the polished surfaces are smooth and devoid of scratches.

2) That no imperfections on tissue surface remain

3) That the borders are sound with no sharp angles in the border areas.

In addition, be sure

1) That the accurate maxillary remount cast is properly attached to the

articulator.

2) That an accurate mandibular cast is prepared for the patient remount.

 STEPS IN INSERTION PROCEDURE
Step I - REVIEWING INSTRUCTIONS

The first step is to review the patient the instructions that were given to him during the diagnostic
phase.

Step II - EVALUATING TISSUE SIDE

Evaluation is done for undercut areas and accuracy of tissue contact.

Step III - EVALUATING BORDERS

Evaluate the borders and the contour of the polished surfaces in the mouth to determine if:

1) The border extensions and contour are compatible with the available spaces in the vestibules.

2) The borders are properly relieved to accommodate the frenum attachments and the reflection of
the tissues in the hamular notch area.

3) The dentures are stable during speech and swallowing.

 Step IV - EVALUATION OF DENTURE SUPPORT
The denture support can be evaluated by applying disclosing paste to inner
portion of the denture and then seating it with considerable finger pressure
over the posterior teeth.

Step V - EVALUATION OF STABILITY

It can be evaluated by grasping the denture and attempting to rotate or
displace it laterally. The amount of movement must be considered relative
to the shape and character of the supporting structures.
 Step VI - EVALUATION OF RETENTION
a. Retention can be evaluated for the maxillary denture by applying
an upward and anterior force on the lingual aspect of the anterior
teeth to indicate the efficiency of posterior border seal.

b. Buccal force on lingual aspect of the posterior teeth on one side indicates
the degree of border seal on the opposite side of mouth.

c. Retention in the posterior portions of the mandibular denture can

be evaluated by applying a downward and Anterior force on the
lingual aspect of the anterior teeth.

d. Anterior retention of mandibular denture can be evaluated by applying a

superiorly directed force.
 Step VII - OCCLUSAL CORRECTION
Occlusal harmony in complete denture is necessary if the dentures are to
be comfortable, to function efficiently and to preserve the supporting
structures.

Postponing this important step will lead to :

1) Deformation of the underlying tissues

2) Discomfort

3) Destruction of supporting bone.

EDUCATION &
INSTRUCTION
Limitations of Usefulness of
Complete Denture

Loss of natural teeth is a misfortune which artificial teeth can reduce but never fully eliminate. Problems created by loss of
natural teeth will not be solved just by replacing with the complete denture because efficiency of natural teeth and dentures
vary.

Limited function of oral tissues will be restored and established with the dentures, but extreme non-functional movements
cannot be performed. Prosthodontic service needs continuous follow-up check-up which includes occlusal correction, relining or
rebasing.
Understanding the Nature of Denture
Foundation

Placement of dentures in the mouth provide unnatural environment to the oral tissues and bone. Soft tissue suffers
compression between bone and denture base.

Pressure and compression in excess of physiological limit of tolerance causes bone resorption and gradual overgrowth of the
tissues creating excessive denture movement.
Complicating Use of Complete
Dentures
The common complicating conditions are:

a. The condition of the supporting structures dictating surgical

intervention, where surgery is either contraindicated or surgery
cannot be performed, complicate use of dentures.
b. Patients presenting with horizontal and vertical loss of
alveolar bone.
c. Patients with uncontrollable tongue and jaw move-ments.
d. Patients who do not accept their responsibility inspite of
excellent prosthodontic treatment.
e. Patients with adverse mental attitude.
f. Lack of mental ability to adjust to the treatment.
Adjustment Period of Dentures and Tissue
Reactions
Soon after the insertion of dentures, salivary flow is stimulated
which declines after 2-3 days. At times there is a feeling of
crowding of the tongue. Feeling of soreness and discomfort
may also be an additional feature.
The patient should be made aware of the limitation to tissue
movements and function in advance of the treatment.
Otherwise, he will not trust the operator and the quality of
service. He should also be advised against carrying out
adjustments to the dentures. Speaking normally with dentures
requires practice. Patients should be advised to read aloud and
repeat words or phrases that are difficult to pronounce.
Learning to use the Dentures Correctly
Successful and efficient use of dentures is a learned process
and patient has to train his musculature in holding the denture.
Patients should be told that the position of the tongue plays an
important role in the stability of a lower denture, particularly
during mastication. Patients whose tongue normally rest in a
retracted position relative to the lower anterior teeth should
attempt to position the tongue further forward so it rests on the
lingual surfaces of the lower anterior teeth. This will help
develop stability for the lower denture.
The lips and cheek should be relaxed and not tensed. Learning
to chew with new dentures usually requires at least 6 to 8
weeks. Use of dentures for chewing should be avoided for the
first 3-4 days.
 Patients should begin with liquid diet followed by relatively soft food in small morsel. If the chewing can be done on both sides
of the mouth at the same time, the tendency of the dentures to tip will be reduced.

Patients should be advised to avoid tearing food with the anterior teeth.

Patients, who have been edentulous without prosthesis for a long time and have learned to crush food between the residual
ridges or perhaps between tongue and the hard palate, will usually take a longer time for adjustment.
Rest to the Supporting Tissues

It is desirable that oral tissues should not remain under continuous stress and therefore it is important to provide rest and
natural ventilation by removing dentures from the mouth. It is advisable to remove dentures during sleeping hours which would
allow tissue to recover from effect of stress. Those patients who suffer discomfort and loss of sleep after removal of dentures
may provide short period of rest to oral tissues during the day.
Mouth and Denture Hygiene

It is important to know that successful use of dentures also depends on the maintenance of oral and denture hygiene. Mouth
should be rinsed after every meal with water and dentures should be gently cleaned using suitable brush. Warm saline rinses
permit penetration of heat causing dilation of blood vessels which would in turn bring fresh nutrients locally contributing to
accelerated repair and regeneration of tissues.

Patients should be discouraged from using tooth pastes, since most contain the abrasive material that will wear away the
surface of acrylic resin. Instead using of soft brush with mild toilet soap is advisable.

The dentures should be left overnight in the cleanser which releases nascent oxygen to release denture plaque and stains
caused due to smoking, high usage of condiments, pan and high intake of greasy food.

The dentures should be brushed over a basin partially filled with water or covered with wet wash cloth to prevent breakage in
case they are dropped. Sterilization of dentures with phenol containing liquids like Dettol should be avoided because it has
softening effect on acrylic. The dentures should be placed in water when not in use in order to prevent shrinkage.
Recall Visits and Their Importance

The objective of recall visits is to offer continuing health service by ensuring the status of supporting tissues. Through recall
visits, one can observe the development of undesirable situations before more damage occurs. Recall visits may be fixed after
every five to six months or one year.
EVALUATION
Problems of complete denture relate to
tissue injury and impaired function
 Tissue Injury
Tissue injury commonly occurs in three of the following areas:

a. Supporting tissue

b. Tissues in contact with borders

c. Tissues that contact the polished surface of the teeth

Injuries to the Supporting/Stress Bearing Tissue

These include mucosa of the crest and slopes of ridges and mucosa of palate. The injuries can be caused by fault in impression,
damage to the master cast and/or disharmony in occlusion. The injuries may be seen as small circumscribed or whitish areas.
Hypertrophy and inflammation may also be a characteristic feature.

Inflammatory reactions may be due to:

i. Lack of rest to the tissue.

ii. Lack of stability of dentures.

iii. Insufficient free way space.

iv. Poor oral hygiene.

v. Nutritional deficiency.

vi. Systemic debilitating disease contributing to poor tissue resistance.

vii. Allergic reaction.

Injuries that Occur to the Tissues in Contact with
the Borders

The lesions usually appear as slit-like fissures or ulcers. The fissures vary in length and depth and are painful. These are caused
by overextensions of denture borders and from sharp thin, unpolished borders of the denture. The overextension refers to
interference with tissue functions and is commonly seen in the following areas:

i. Frenum attachment.

ii. Retromylohyoid tissue.

iii. Retromolar pad.

iv. Massetric notch.

v. Hamular notch.

vi. Floor of the mouth.

vii. Soft palate.

 Injuries that occur to the Tissue in Contact with
Polished Surface of the Denture Base and Teeth

These may be caused by:

i. Cheek biting.

ii. Rough margins of the teeth.

iii. Tongue biting.

iv. Unpolished denture bases.

v. Porous dentures.
 IMPAIRMENT OF FUNCTION

Functions that can be impaired due to ill-fitting dentures can be broadly related to the following:

1. Esthetics

2. Phonetics

3. Mastication

4. Retention

5. Stability

6. Gagging.
Esthetics
The patient may be dissatisfied with the appearance if proper
care has not been taken during jaw relation recording
procedure followed by teeth selection and arrangement. The lip
support, visibility and plane should be adjusted accurately
during jaw relation recording procedure that contributes to
esthetics. Teeth selection and arrangement should be done to
restore natural look of the patient.
Phonetics

Problems in speech may be caused by excessive thickness of

the denture base or improper arrangement of teeth. Mastication
The problem in mastication is mainly due to wrong selection of
posterior teeth and or improper arrangement of posterior teeth.
Retention Lack of retention is mainly due to improper recording
of impression with failure to record the denture bearing and
peripheral-limiting structures.
Stability

Stability may be lost due to improper impression procedure and arrangement of teeth.
Gagging

It may be caused by overextension of the denture or unhygienic procedures

followed during the treatment.
MANAGEMENT OF POST DENTURE INSERTION
PROBLEMS

Pain in the Labial, Buccal and Lingual Sulcus and Frenum

Localized reduction of the overextended flange.

Create allowance for frenum movement.

Rounding off the sharp margins and smoothening the borders.

Localized Tender or Painful Area on the Denture-bearing Surface

Identify and eliminate the blow out nodules, spikes and sharp ridges
 Wide Painful Areas on the Residual Ridge and Palate

The premature contact area of teeth should be corrected.

If it is due to increased vertical dimension, the entire procedure should be repeated.

If vertical dimension and centric relation is correct, denture relining can be accomplished.

Burning Sensation in the Anterior Region of the Lingual

Sulcus
The overextension in the lingual sulcus should be identified and corrected.

Difficulty in Swallowing
The overextension in the distolingual sulcus should be corrected.
Cheek, Lip and Tongue Biting

This can be caused due to decreased vertical dimension, inadequate overjet of posterior teeth and increased overjet in anterior
teeth, which should be identified and corrected.

Loss of Retention
The under extended borders and inadequate adaptation of denture base to the denture-bearing tissues can be corrected by
relining procedure.

Gagging
The overextended posterior border and distolingual flange should be corrected.
The excessive thickness of the palatal aspect of the denture should be reduced.
Maintenance of hygiene.
Posterior palatal seal area should be corrected.
Topical anesthetics can be advised.
Psychological counselling.
Loss of Stability
The procedure should be repeated in order to correct the occlusal discrepancy. If it is due to faulty denture adaptation, relining
should be done.

Reduced Masticatory Efficiency

Occlusal correction should be accomplished.

Poor Appearance
If there is excessive bulk on the buccal or labial aspect, it can be reduced.
The treatment should be repeated. in case of other problems like midline off-center, faulty vertical dimension, improper selection
of teeth.
Difficultly in Speech
The patient should be educated that since denture is a foreign body it will take some time for the patient to get accustomed to it.
Patient should be instructed to read newspaper or magazines aloud to get accustomed to the new denture. If the patient still
complains of speech problems, the thickness of the palatal aspect should be reduced. If it is due to faulty arrangement of teeth,
the treatment will need to be repeated.
 Referensi

Sarandha D.L. 2007. Textbook of Complete Denture

PROSTHODONTICS. New Delhi: Jaypee Brothers Medical
Publishers.

Dr. Shikha Nandal,et al. 2014. Complete-denture insertion

appointment: what to look for?. International Journal of
Enhanced Research in Medicines & Dental Care
THANK YOU